Income And Expense Statement printable pdf download

Income And Expense Statement

IN THE ________ JUDICIAL CIRCUIT COURT, _______________________, MISSOURI

Judge or Division:

Case Number:

In RE the Marriage of :

Petitioner:

vs.

SSN (Last Four Digits):

Respondent:

SSN (Last Four Digits):

(Date File Stamp)

Income and Expense Statement of __________________________________

I. My Income

Gross wages or salary and commissions paid to me each pay period:

Paid:

Weekly __________ Bi-Weekly __________ Semi-Monthly _________ Monthly ________

My monthly gross wages or salary:

C. My tax status claimed: Single __________ Married __________ Head/Household ___________

Number of persons claimed as deductions __________

D. Payroll deductions each pay period:

FICA (social security tax)

Federal withholding tax

State withholding tax

City earning tax

Union dues

Health insurance

Others: (specify)

My total deductions each pay period:

My net take home pay each pay period:

My take home or net pay each month:

Amount

Source

My total monthly average gross additional income from all sources

G. My total monthly gross income from wages (line B) and additional income (line F)

H. Total gross income from my tax returns for each of the last 3 calendar years:

Year

Income

OSCA (6-95) CV100

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Income And Expense Statement